End of service summary report for mobile cardiac outpatient telemetry

ABSTRACT

A method for filtering ECG data includes receiving ECG data of a patient, generating an ECG report comprising a plurality of pages, and presenting priority information on a first page of the plurality of pages. The priority information includes information identifying the patient, monitoring summary information including an indication of a total duration of a monitoring period, heart rate summary information including an average heart rate, a fastest heart rate, and a slowest heart rate, representative arrhythmia summary information including a count of ECG strips containing each of a plurality of types of cardiac arrhythmia, and atrial fibrillation summary information including an indication of atrial fibrillation burden during the monitoring period. The first page of the report does not include an ECG strip.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. application Ser. No. 15/678,594, filed Aug. 16, 2017, now allowed, which claims priority to U.S. Provisional Application No. 62/375,738, filed on Aug. 16, 2016, the content of which is incorporated herein by reference in its entirety.

A portion of the disclosure of this patent document contains material which is subject to copyright protection. The copyright owner has no objection to the facsimile reproduction by anyone of the patent document or the patent disclosure, as it appears in the Patent and Trademark Office patent file or records, but otherwise reserves all copyright rights whatsoever.

BACKGROUND

Cardiac arrhythmia includes a group of conditions in which a heartbeat is irregular. For example, the heartbeat may be too fast (tachycardia) or too slow (bradycardia). Atrial fibrillation (AF) is the most common type of arrhythmia. During AF, one or both of the heart's upper chambers (atria) do not contract properly, thus impeding the pumping of blood into the lower chambers (ventricles). Cardiac arrhythmia, such as AF, affects millions of people and may result in palpitations, lightheadedness, shortness of breath, fainting (syncope), chest pain, stroke, heart failure, and cardiac arrest. In some patients, cardiac arrhythmia events, such as periods of time during which the heartbeat is too fast or too slow, do not occur frequently. Instead, cardiac arrhythmia events may occur infrequently, such as every few days.

Cardiac arrhythmia events can be detected by measuring a patient's electrocardiogram (ECG), which is a recording of the electrical activity of the heart. To detect cardiac arrhythmia events that occur infrequently, it may be impractical to require a patient to undergo ECG recording at a hospital for the length of time required to detect an event. Instead, it may be desirable to record the patient's ECG outside of the hospital. Thus, devices for recording ECG data that a patient can wear during normal life activities have been developed. These devices may include electrodes for measuring ECG data, a sensor to store the ECG data, and a means for enabling the user to wear the sensor, such as a lanyard worn around the neck. Collected ECG data may be obtained by a physician through different methods. For example, the device can transmit the ECG data directly to the physician over a cellular or wireless network. Such a system is called mobile cardiac outpatient telemetry (MCOT).

During monitoring with an MCOT device, algorithms in the device may analyze collected ECG data for findings. Examples of findings are atrial fibrillation, heart block, pause, supraventricular tachycardia, and ventricular tachycardia. During monitoring with an MCOT device, a patient may have the ability to record a symptom that the patient is experiencing during a given time period. For example, the MCOT device may have a display from which the patient can choose a symptom from a menu of symptom options. The recorded symptom may then be saved along with data collected at the time when the symptom is recorded for inclusion in the patient report. Examples of symptoms are heart racing, shortness of breath, skipped beat, chest pain, light headedness, fainting, and dizziness. Data collected in connection with a recorded symptom may be considered “symptomatic.” During monitoring with an MCOT device, a patient may not experience a symptom, but algorithms analyzing the collected data may detect a finding in the collected data and save the data along with an indication that the patient was asymptomatic. Such data may be considered “asymptomatic” and/or “auto triggered.” During monitoring with an MCOT device, a patient may also be able to record a certain level of activity (e.g., heavy activity) that the patient was engaging in at a certain time in a similar manner as recording symptoms.

Because MCOT monitoring periods can be long (for example, 5 days, 10 days, 15 days, 20 days, 25 days, 30 days, etc.), the amount of data collected by the MCOT device can be large. To ensure that the collected data can be used productively by a physician, it is important to filter the collected data for presentation to the physician on a report in a manner that helps the physician interpret the data efficiently and effectively. Existing priority data filters and reports suffer from multiple drawbacks. For example, in some patient reports, priority data filters do not retain sufficiently organized information, and/or do not retain a sufficient portion of priority information for inclusion on the reports' first pages, making it necessary to search through multiple pages of the reports for priority information. In some patient reports, existing priority data filters retain graphs and strips for the first page of the report, which is typically the focus of a physician reviewing the report. Therefore, the first page of the report becomes overburdened with graphs and strips that consume space. As used herein, “strips” refer to images of ECG data that may be presented to a physician in a report.

Specific examples of patient reports in the prior art are the patient reports produced by Medicomp (see FIGS. 1-3 ), MediLynx (FIG. 4 ), and iRhythm (FIG. 5 ). The first page of each patient report has a number of graphs, charts, and/or strips which occupy space on the first page that could be used for other types of information.

A further problem in processing collected ECG data for a patient report is providing accurate high heart rate information. In preparing some patient reports, algorithms that calculate high heart rate from collected ECG data may produce a high heart rate value that is corrupted by artifacts. A further problem in processing collected ECG data for a patient report is providing accurate low heart rate information. In preparing some patient reports, algorithms that calculate low heart rate from collected ECG data may produce a low heart rate value that is corrupted by a pause event.

SUMMARY

The data filter and report described herein have multiple benefits that address these drawbacks. The priority data filter retains priority information from collected MCOT data that a physician needs for interpreting the collected data, and this priority information is presented on the first page of the report, which is typically the focus of a physician reviewing the report. This is helpful because the physician does not need to search through multiple pages of the report to find important information needed for interpreting the collected data. The priority data filter does not retain graphs or strips for inclusion on the first page of the report. This is helpful because graphs and strips occupy a large amount of space, and therefore including graphs and strips on the first page may not be the most efficient use of space on the first page. For example, while a strip may show detailed information about one event, the space occupied by that strip can instead be used for showing other priority information retained by the priority data filter, such as summary information about multiple events. The report also organizes information from the collected data by category for presentation in the report. For example, information about AF is organized and presented in its own section of the report and information about HR is organized and presented in its own section of the report. This is helpful because the physician, when considering, for example, AF, will have the AF information in one section and will not have to search through multiple pages of the report to find information about AF. Furthermore, organizing information in the report by category means that the information is presented in a more sensible and understandable manner and may help the physician interpret the data efficiently and effectively as the physician reads through the report. The patient report also places important information, such as summary information regarding AF and HR, near the front of the report, while keeping other information such as strips towards the back of the report.

In preparing the patient report discussed herein, algorithms for calculating high heart rate may reduce the chance of including a high heart rate value that is inaccurate due to artifacts. To accomplish this, the patient report may show the highest heart rate calculated by the algorithms that is associated with data that has an acceptably low number of artifacts, even if the other data that contains artifacts indicates a higher heart rate. Additionally, in preparing the patient report discussed herein, algorithms for calculating low heart rate may reduce the chance of including a low heart rate value that is inaccurate due to a pause event. To accomplish this, the algorithms may recognize pause events and prevent the pause event from inclusion in calculations of low heart rate.

In one aspect, a method for filtering ECG data includes receiving ECG data of a patient, generating an ECG report comprising a plurality of pages, presenting, on a first page of the plurality of pages: information identifying the patient, monitoring summary information including an indication of a total duration of a monitoring period, heart rate summary information including an average heart rate, a fastest heart rate, and a slowest heart rate, representative arrhythmia summary information including a count of ECG strips containing each of a plurality of types of cardiac arrhythmia, and atrial fibrillation summary information including an indication of atrial fibrillation burden during the monitoring period. The first page does not include an ECG strip.

In some implementations, the first page does not include a graph of ECG data. In certain implementations, the method also includes excluding a portion of the ECG data from calculation of the lowest heart rate if the portion includes a pause event. In some implementations, the method also includes receiving an artifact threshold and excluding a portion of the ECG data from calculations of the highest heart rate if the portion includes an amount of artifact that exceeds the artifact threshold.

In certain implementations, the representative arrhythmia summary information includes the date, time, and heart rate corresponding to: a fastest atrial fibrillation, a fastest supraventricular tachycardia, a longest pause, a slowest heart block, and a fastest ventricular tachycardia. In some implementations, the representative arrhythmia summary information includes a count of ECG strips containing atrial fibrillation, a count of ECG strips containing heart block, a count of ECG strips containing pause, a count of ECG strips containing supraventricular tachycardia, and a count of ECG strips containing ventricular tachycardia. In certain implementations, symptomatic arrhythmia events are counted separately from asymptomatic arrhythmia events. In some implementations, the representative arrhythmia summary information includes, for symptomatic arrhythmia events, an indication of symptoms associated with the symptomatic arrhythmia events as recorded by the patient.

In some implementations, the method also includes presenting event summary information on the first page, and the event summary information includes an indication of an earliest page on which ECG strips are presented. In certain implementations, the event summary information includes an indication of a total number of ECG strips presented in the report. In some implementations, the monitoring summary information further includes a number of days for which a monitoring device was prescribed to the patient, a number of days in which monitoring occurred, a baseline date, and an end date. In certain implementations, the heart rate summary information includes the date and time at which the highest heart rate occurred and the date and time at which the lowest heart rate occurred. In some implementations, the atrial fibrillation summary information includes total time in atrial fibrillation, number of atrial fibrillation episodes, longest atrial fibrillation, highest heart rate during atrial fibrillation, lowest heart rate during atrial fibrillation, average heart rate during atrial fibrillation, highest heart rate not during atrial fibrillation, lowest heart rate not during atrial fibrillation, and average heart rate not during atrial fibrillation.

In certain implementations, the method also includes presenting, on a second page, a histogram of atrial fibrillation duration, a histogram of atrial fibrillation onset, and an indication of daily atrial fibrillation burden for each of a plurality of days in the monitoring period. In some implementations, the method also includes presenting, on the second page, total time in atrial fibrillation, number of atrial fibrillation episodes, longest atrial fibrillation, highest heart rate during atrial fibrillation, lowest heart rate during atrial fibrillation, average heart rate during atrial fibrillation, highest heart rate not during atrial fibrillation, lowest heart rate not during atrial fibrillation, and average heart rate not during atrial fibrillation.

In another aspect, a system for filtering ECG data includes a processor and computer-readable memory storing instructions which, when executed by the processor, cause the processor to perform operations. The operations include receiving ECG data of a patient, generating an ECG report comprising a plurality of pages, and presenting, on a first page of the plurality of pages: information identifying the patient, monitoring summary information, heart rate summary information, representative arrhythmia summary information, and atrial fibrillation summary information. The first page does not include an ECG strip. The monitoring summary information includes an indication of a total duration of a monitoring period, the heart rate summary information includes an average heart rate, a fastest heart rate, and a slowest heart rate. The representative arrhythmia summary information includes a count of ECG strips containing each of a plurality of types of cardiac arrhythmia. The atrial fibrillation summary information includes an indication of atrial fibrillation burden during the monitoring period.

In some implementations, the first page does not include a graph of ECG data. In certain implementations, the operations also include excluding a portion of the ECG data from calculation of the lowest heart rate if the portion includes a pause event. In some implementations, the operations also include receiving an artifact threshold and excluding a portion of the ECG data from calculations of the highest heart rate if the portion includes an amount of artifact that exceeds the artifact threshold. In certain implementations, the representative arrhythmia summary information includes the date, time, and heart rate corresponding to: a fastest atrial fibrillation, a fastest supraventricular tachycardia, a longest pause, a slowest heart block, and a fastest ventricular tachycardia.

Variations and modifications will occur to those of skill in the art after reviewing this disclosure. The disclosed features may be implemented, in any combination and subcombination (including multiple dependent combinations and subcombinations), with one or more other features described herein. The various features described or illustrated above, including any components thereof, may be combined or integrated in other systems. Moreover, certain features may be omitted or not implemented.

BRIEF DESCRIPTION OF DRAWINGS

The foregoing and other objects and advantages will be apparent upon consideration of the following detailed description, taken in conjunction with the accompanying drawings, in which like reference characters refer to like parts throughout, and in which:

FIGS. 1A and 1B, 2A and 2B, and 3A and 3B show first pages of patient reports in the prior art, produced by Medicomp;

FIGS. 4A and 4B show a first page of a patient report in the prior art, produced by MediLynx;

FIGS. 5A and 5B show a first page of a patient report in the prior art, produced by iRhythm;

FIGS. 6A and 6B show an illustrative first page 100 of an end of service summary report in accordance with some embodiments of the disclosure;

FIGS. 7A and 7B show an illustrative page 200 of an end of service summary report in accordance with some embodiments of the disclosure;

FIGS. 8A and 8B show an illustrative page 300 of an end of service summary report in accordance with some embodiments of the disclosure;

FIGS. 9A and 9B show an illustrative page 400 of an end of service summary report in accordance with some embodiments of the disclosure;

FIGS. 10A and 10B show an illustrative page 500 of an end of service summary report in accordance with some embodiments of the disclosure;

FIGS. 11A and 11B show an illustrative page 600 of an end of service summary report in accordance with some embodiments of the disclosure;

FIGS. 12A and 12B show an illustrative page 700 of an end of service summary report in accordance with some embodiments of the disclosure;

FIGS. 13A and 13B show an illustrative page 800 of an end of service summary report in accordance with some embodiments of the disclosure; and

FIGS. 14-30 show further illustrative pages of the end of service summary report in accordance with some embodiments of the disclosure

DETAILED DESCRIPTION

To provide an overall understanding of the data filter and end of service summary report for mobile cardiac outpatient telemetry, certain illustrative embodiments will be described. Although the embodiments and features described herein are specifically described for use in connection with data filters and end of service summary reports for mobile cardiac outpatient telemetry, it will be understood that all the features outlined below may be combined with one another in any suitable manner and may be adapted and applied to other types of patient reports for other types of monitoring.

FIGS. 1-5 are discussed above in the Background.

FIGS. 6A and 6B show an illustrative first page 100 of an end of service summary report in accordance with some embodiments of the disclosure. A priority data filter analyzing data collected by the MCOT device retains priority information from the collected data. The priority information retained by the priority data filter is presented on the first page 100 and will be discussed below in relation to various sections of the first page 100 that contain the priority information. The priority information is included in a patient and physician information section 102, a monitoring summary section 104, an event summary section 106, a heart rate (HR) summary section 108, a representative arrhythmia summary section 110, an atrial fibrillation (AF) summary section 112, and a physician comments section 114.

The patient and physician information section 102 includes information retained by the priority data filter about the patient's name, the patient's date of birth, the patient's gender, the patient's phone number, the patient's medical record, the patient's diagnosis, the notification physician's name and address, the ordering physician's name, and the referring physician's name.

The monitoring summary section 104 includes information retained by the priority data filter about the total time period in which monitoring occurred, the number of days for which the MCOT device was prescribed to the patient, the number of days in which monitoring occurred, a baseline date, and an end date.

The event summary section 106 includes information retained by the priority data filter about the total number of strips present in the report, the number of strips in which the patient was symptomatic, the number of strips in which show emergent/urgent findings. The event summary section 106 includes an indication of on which page of the report strips begin to be presented. This indication can be helpful in avoiding a physician needing to search through an entire report in order to find strips.

The HR summary section 108 includes information retained by the priority data filter about the value of the highest heart rate during the monitoring period, the date and time at which the highest heart rate occurred, the value of the lowest heart rate during the monitoring period, the date and time at which the lowest heart rate occurred, and the average heart rate from the monitoring period.

The HR summary section 108 includes an indication of on which page of the report information about daily heart rate and strips relating to high and low heart rate are presented. As discussed above, the first page 100 does not contain strips, in order to conserve space on the first page 100. However, a physician may wish to see strips in conjunction with information that is presented on the first page 100. For example, the physician may wish to see strips associated with high and low heart rate. The indication of where in the report strips can be found helps the physician navigate from the first page 100 to the strips, without requiring that the physician search through multiple pages of the report, and avoids or reduces the need for the relevant strips to actually be presented on the first page 100.

The representative arrhythmia summary section 110 includes information retained by the priority data filter regarding various types of arrhythmia. For example, the top section of the representative arrhythmia summary section 110 includes information about atrial fibrillation (AF). In particular, this section includes information about the fastest AF (i.e., AF associated with the highest rate) that occurred during the monitoring period. The date, time, and heart rate is shown for the fastest AF in both symptomatic and asymptomatic conditions. For the symptomatic fastest AF, the symptoms recorded by the patient are also shown. Detailed information is shown here for the fastest symptomatic and asymptomatic AF that occurred during the monitoring period. However, there may have been multiple occurrences of symptomatic and asymptomatic AF during the monitoring period. Accordingly, the representative arrhythmia summary section 110 also includes a total strip count describing how many strips with findings of symptomatic AF are in the report and how many strips with findings of asymptomatic AF are in the report. The representative arrhythmia section includes similar information for fastest supraventricular tachycardia (SVT), longest pause, slowest heart block, and fastest ventricular tachycardia (VT). The representative arrhythmia summary section 110 also includes an indication of on which page of the report strips begin to be presented. This indication is helpful for similar reasons as discussed above in relation to the indication in the HR summary section 108.

The AF summary section 112 includes information retained by the priority data filter about AF burden, analysis time, total time in AF, number of AF episodes, longest AF, highest heart rate during AF, lowest heart rate during AF, average heart rate during AF, highest heart rate not during AF, lowest heart rate not during AF, and average heart rate not during AF.

In the physician comments section 114, a physician reading the report can insert comments and sign his/her name. As discussed above, the priority information that a physician would need is retained by the priority data filter and included on the first page 100. Accordingly, the priority data filter and the report help the physician be more efficient and effective by providing the physician with the ability to analyze the priority data, provide comments, and sign, all while using just the first page 100 of the report.

The priority data filter retains priority information that a physician needs for interpreting collected data. This priority information is presented on the first page 100 of the report. This is helpful because the physician does not need to search through multiple pages of the report to find important information needed for interpreting the collected data. Also, the priority data filter does not retain graphs and strips for inclusion on the first page 100 of the report. This is helpful because graphs and strips occupy a large amount of space, and therefore including graphs and strips on the first page may not be the most efficient use of space on the first page. For example, while a strip may show information about one event, the space occupied by that strip can be used for showing other priority information retained by the priority data filter, such as information about multiple events. For example, rather than showing a strip about one event, it is possible to show on the first page 100 summary information about twelve events in the representative arrhythmia summary section 110.

FIGS. 7A and 7B show a page 200 of an end of service summary report in accordance with some embodiments of the disclosure. The page 200 includes a first documented AF section 202, an AF duration and onset distribution section 204, and daily AF summary sections 206 and 207. The first documented AF section 202 show the date, time, heart rate, recorded symptoms (if any), recorded activities (if any), findings, and strip associated with the first occurrence of AF detected during the monitoring period. Information regarding the first occurrence of AF is important for a physician in analyzing data from an MCOT device. Accordingly, inclusion of information and a strip regarding the first occurrence of AF in its own section, near the beginning of the report, can be helpful in enabling the physician to efficiently and effectively analyze data from the MCOT device.

The AF duration and onset distribution section 204 shows histograms of AF data. A duration histogram 208 shows how many and what percentage of the total AF episodes occurred within a number of ranges of times. For example, the duration histogram 208 shows that 3 AF episodes, corresponding to 38% of the total AF episodes, were of a duration between 6 minutes and 30 minutes. An onset histogram 210 shows how many and what percentage of the total AF episodes occurred within a number of ranges of times of day. For example, the onset histogram 210 shows that 4 AF episodes, corresponding to 80% of the total AF episodes, had onsets between 12 pm and 6 pm. The AF duration and onset distribution section 204 also shows an indication of the total count of AF episodes during the monitoring period.

The daily AF summary sections 206 and 207 show bar graphs of AF data. In particular, for each of days 1-14 of the monitoring period, the daily AF summary sections 206 and 207 shows the total monitored time for the day, how much of the monitored time was spent in AF, and how much of the monitored time was spent not in AF. For example, in the daily AF summary section 207, the total monitored time for August 3 was 23 hours and 45 minutes, the total time spent in AF was 16 hours and 48 minutes, the percentage of the monitored time spent in AF was 71%, and the number of AF events was 2. Additionally, the height of the bar for August 3, when read against the vertical time axis, shows the total monitored time, the height of the blue section of the bar shows the total time spent in AF, and the height of the white section of the bar shows the total time not spent in AF. A legend indicates the meanings of the blue and white colors. The daily AF summary section 206 shows daily AF summary data for days 1-7 of the monitoring period and the daily AF summary section 207 shows daily AF summary date for days 8-14 of the monitoring period.

FIGS. 8A and 8B show a page 300 of an end of service summary report in accordance with some embodiments of the disclosure. The page 300 includes a daily AF summary section 302, a high HR confirmation strip section 304, a low HR confirmation strip section 306, and a daily HR section 308.

The daily AF summary section 302 is a continuation of the daily AF summary sections 206 and 207, showing daily AF summary data for days 15-21 of the monitoring period.

When page 200 and page 300 are adjacent to each other, the first documented AF section 202, the AF duration and onset distribution section 204, and the daily AF summary sections 206, 207, and 302 are adjacent to each other. Accordingly, information about AF summary can be found in one section organized around AF. This is helpful because the physician, when considering AF, will have the AF information in one section and will not have to search through multiple pages of the report to find information about AF. Furthermore, organizing information in the report by category means that the information is presented in a more sensible and understandable manner and may help the physician interpret the data efficiently and effectively as the physician reads through the report.

Certain bars in the daily AF summary sections 206 and 207 are filled with hatch lines. The legend indicates that hatch lines refer to incalculable AF. It may not be possible to calculate time spent in AF during a certain time period if, for example, artifacts occur in data from that time period. In addition to the hatch lines, a letter “(a)” on the bars with incalculable AF directs a physician reading the report to a disclaimer 310. The disclaimer 310 indicates that AF is present but due to episodes of <30 seconds in duration and/or presence of significant artifact, AF burden cannot be accurately calculated. Including the disclaimer 310 helps a physician avoid confusion about why AF may not have been calculated for a certain time period.

The high HR confirmation strip section 304 shows information about the time, date, heart rate value, recorded symptoms, recorded activities, and findings associated with the occurrence of the highest heart rate during the monitoring period. In some cases, algorithms for calculating the highest heart rate during the monitoring period may find that data associated with the occurrence of the highest heart rate contains artifacts. Accordingly, the algorithms may not have an acceptably high confidence that the highest heart value is accurate, rather than being due to the artifacts. In such situations, the patient report may not show this data. Instead, the patient report may show the highest heart rate associated with data that has an acceptably low number of artifacts, even if the other data that contains the artifacts indicates a higher heart rate. Accordingly, a physician reviewing the chart may be able to have confidence that the high heart rate information shown in the high HR confirmation strip section 304 is not corrupted by artifacts. The physician may be able to request, separately from the report, the other high heart rate information about which the algorithms did not have acceptably high confidence.

The low HR confirmation strip section 306 shows information about the time, date, heart rate value, recorded symptoms, recorded activities, and findings associated with the occurrence of the lowest heart rate during the monitoring period. In some cases, it is possible for a pause to corrupt calculation of lowest heart rate. For example, heart rate may be calculated by counting the number of beats during a given window of time, such as 20 seconds. If during that 20-second window, 10 beats occurred in the first 10 seconds, while a 10-second long pause occurred in the last 10 seconds, the heart rate may be calculated as 30 bpm. However, a more accurate interpretation of this data may be that a period of 60 bpm heart rate was followed by a 10-second pause. In other words, the occurrence of the pause may be a more important finding than the contribution of the pause to a low heart rate calculation. In such situations, the patient report may not include the pause event in calculations of lowest heart rate. Following the above example, the 10-second long pause would not be included in the calculation of heart rate. Accordingly, a physician reviewing the chart may be able to have confidence that the low heart rate information shown in the low HR confirmation strip section 306 is not corrupted by a pause. However, the pause, being a significant finding, would likely be represented in another portion of the report.

The daily HR section 308 shows a chart of HR data from days 1-7 of the monitoring period. In particular, the daily HR section 308 shows, for each day, the highest HR that occurred during a period of no AF, the lowest HR that occurred during a period of no AF, the average HR that occurred during periods of no AF, the highest HR that occurred during a period of AF, the lowest HR that occurred during a period of AF, and the average HR that occurred during periods of AF. For example, on July 19, the highest HR that occurred during a period of no AF was 201 bpm, the lowest HR that occurred during a period of no AF was 30 bpm, the average HR that occurred during periods of no AF was 87 bpm, the highest HR that occurred during a period of AF was 200 bpm, the lowest HR that occurred during a period of AF was 73 bpm, and the average HR that occurred during periods of AF was 77 bpm. In addition, for each day, the position of a yellow square, when read against the vertical axis, represents the average HR during periods of AF, and the position of a blue diamond represents the average HR during periods of no AF. Furthermore, the tip of a yellow line extending upwards represents the highest HR that occurred during a period of AF, the tip of a yellow line extending downwards represents the lowest HR that occurred during a period of AF, the tip of a blue line extending upwards represents the highest HR that occurred during a period of no AF, the tip of a blue line extending downwards represents the lowest HR that occurred during a period of no AF. A legend indicates the meaning of the shapes and colors of the chart. In some cases, if the lowest and/or highest HR value is close to the average HR value, lines indicating the lowest and/or highest HR values may not be visible beyond the shape representing the average HR value. For example, on July 19, the yellow square represents the average HR value of 77 during periods of AF, the tip of the yellow line extending upwards represents the highest HR value of 200 that occurred during periods of AF, but no yellow line extending downwards is visible because the lowest HR value of 73 that occurred during periods of AF is close to the average HR value of 77 during periods of AF.

FIGS. 9A and 9B show a page 400 of an end of service summary report in accordance with some embodiments of the disclosure. The page 400 includes daily HR sections 402 and 403 and emergent/urgent summary section 404. The daily HR sections 402 and 403 are continuations of the daily HR section 308, showing daily AF summary data for days 8-14 and 15-21, respectively, of the monitoring period. For certain days in the daily HR sections 308, 402, and 403, information regarding HR during AF is not present. For similar reasons as discussed above, it may not be possible to calculate time spent in AF if, for example, artifacts occur in data. A letter “(a)” directs a physician reading the report to a disclaimer 406 similar to disclaimer 310. Including the disclaimer 406 helps the physician avoid confusion about why AF may not have been calculated.

When page 300 and page 400 are adjacent to each other, the high HR confirmation strip section 304, the low HR confirmation strip section 306, and the daily HR sections 308, 402, and 403 are adjacent to each other. Accordingly, information about HR summary can be found in one section organized around HR. This is helpful because the physician, when considering HR, will have HR information in one section and will not have to search through multiple pages of the report to find information about HR. Furthermore, organizing information in the report by category means that the information is presented in a more sensible and understandable manner and may help the physician interpret the data efficiently and effectively as the physician reads through the report.

The emergent/urgent summary section 404 lists times, dates, recorded symptoms, findings, and heart rates for emergent/urgent events. The time and date for each emergent/urgent event can be used to find the corresponding strip in a strip section later in the report.

FIGS. 10A and 10B show a page 500 of an end of service summary report in accordance with some embodiments of the disclosure. The page 500 includes a continuation of the emergent/urgent summary section 404.

FIGS. 11A and 11B show a page 600 of an end of service summary report in accordance with some embodiments of the disclosure. The page 600 includes a continuation of the emergent/urgent summary section 404 and a symptomatic events summary section 602. The symptomatic events summary section 602 lists times, dates, recorded symptoms, findings, and heart rates for events associated with patient recordings of symptoms. The time and date for each symptomatic event can be used to find the corresponding strip in a strip section later in the report.

FIGS. 12A and 12B show a page 700 of an end of service summary report in accordance with some embodiments of the disclosure. The page 700 includes a continuation of the symptomatic events summary section 602.

FIGS. 13A and 13B show a page 800 of an end of service summary report in accordance with some embodiments of the disclosure. The page 800 includes a continuation of the symptomatic events summary section 602 and a strip summary section 802. The strip summary section 802 includes, for each collected event, the time, date, finding, recorded symptom, recorded activity, heart rate, and strip. Events are listed in chronological order in the strip summary section 802. Accordingly, if an event with a particular time and date is identified elsewhere in the report (e.g., the HR summary section 108, the representative arrhythmia summary section 110, the first documented AF section 202, the high HR confirmation strip section 304, the low HR confirmation strip section 306, the emergent/urgent summary section 404, and the symptomatic events summary section 602), a physician reviewing the report can easily find the corresponding strip in the strip summary section 802. The strip summary section 802 is present towards the end of the report. Not including many strips at the beginning of the report is beneficial because strips occupy a large amount of space, and therefore including strips at the beginning of the report, which may be the focus of the physician's attention, may not be the most efficient use of space on the first page. For example, while a strip may show detailed information about one event, the space occupied by that strip could be used for showing information about multiple events.

FIGS. 14-30 show further illustrative pages of the end of service summary report in accordance with some embodiments of the disclosure that include continuations of the strip summary section 802.

Certain events may have two associated findings. For example, a single event may have findings of advanced heart block and 8 second pause. In such a case, the same event may be shown as two strips in the strip summary section 802. As seen in FIG. 19 , a single event on Jul. 20, 2016, at 4:59:11 PDT corresponds to both advanced heart block at 8 second pause. Accordingly, it may be important to ensure that findings are counted in terms of strips, and not in terms of events. Otherwise, the above example would be counted as just one event even though there are two corresponding strips, which could be confusing for a physician reviewing the report. As seen in the representative arrhythmia summary section 110, for example, total strip counts, rather than total event counts, are shown.

The foregoing is merely illustrative of the principles of the disclosure, and the data filter and report can be practiced by other than the described embodiments, which are presented for purposes of illustration and not of limitation. It is to be understood that while various sections are described as occurring on certain pages of a report, the sections can also be presented on other pages of the report, and various sections can be presented in different orders than the order described above.

Variations and modifications will occur to those of skill in the art after reviewing this disclosure. The disclosed features may be implemented, in any combination and subcombination (including multiple dependent combinations and subcombinations), with one or more other features described herein. The various features described or illustrated above, including any components thereof, may be combined or integrated in other systems. Moreover, certain features may be omitted or not implemented.

Examples of changes, substitutions, and alterations are ascertainable by one skilled in the art and could be made without departing from the scope of the information disclosed herein. All references cited herein are incorporated by reference in their entirety and made part of this application. 

We claim:
 1. A method for filtering and indexing ECG data, the method comprising: receiving ECG data of a patient and indications of patient-recorded symptoms from a mobile cardiac telemetry device; identifying atrial fibrillation events in the received ECG data; for each identified atrial fibrillation event, filtering the received ECG data to determine whether the identified atrial fibrillation event coincided temporally with at least one patient-recorded symptom, and labeling each such coinciding identified atrial fibrillation events as an asymptomatic AF strip and each non-coinciding identified atrial fibrillation events as an asymptomatic AF strip; generating an ECG report based on the filtered ECG data, the report comprising a sequence of a plurality of pages; presenting, on a first page in the sequence of the plurality of pages: representative arrhythmia summary information including a count of ECG strips containing each of a plurality of types of cardiac arrhythmia, and atrial fibrillation summary information including an indication of atrial fibrillation burden during the monitoring period; a count of symptomatic AF strips; and a count of asymptomatic AF strips; wherein at least one page of the plurality of pages includes an ECG strip, but the first page in the sequence does not include an ECG strip; determining a strip address by determining an earliest page of the sequence of the plurality of pages that includes an ECG strip; determining an AF summary address by determining an earliest page of the sequence of the plurality of pages that includes the atrial fibrillation summary information; and presenting, on the first page in the sequence, an address index comprising: a strip pointer comprising the strip address and, adjacent thereto, a signifier of an ECG strip; and an AF summary pointer comprising the AF summary address and, adjacent thereto, a signifier of atrial fibrillation.
 2. The method of claim 1, wherein the first page does not include a graph of ECG data.
 3. The method of claim 2, further comprising calculating the lower heart rate of the patient, wherein a portion of ECG data is excluded from calculation of the lowest heart rate if the portion includes a pause event.
 4. The method of claim 2, further comprising: receiving an artifact threshold, and calculating the highest heart rate of the patient, wherein a portion of ECG data is excluded from calculation of the highest heart rate if the portion includes an amount of artifact that exceeds the artifact threshold.
 5. The method of claim 2, wherein the representative arrhythmia summary information includes the date, time, and heart rate corresponding to: a fastest atrial fibrillation, a fastest supraventricular tachycardia, a longest pause, a slowest heart block, and a fastest ventricular tachycardia.
 6. The method of claim 5, further comprising counting of ECG strips pertaining to arrhythmia events included in the representative arrhythmia summary, wherein the representative arrhythmia summary information includes a count of ECG strips containing atrial fibrillation, a count of ECG strips containing heart block, a count of ECG strips containing pause, a count of ECG strips containing supraventricular tachycardia, and a count of ECG strips containing ventricular tachycardia.
 7. The method of claim 6, wherein symptomatic arrhythmia events are counted separately from asymptomatic arrhythmia events.
 8. The method of claim 7, wherein the representative arrhythmia summary information includes, for symptomatic arrhythmia events, an indication of symptoms associated with the symptomatic arrhythmia events as recorded by the patient.
 9. The method of claim 8, further comprising presenting event summary information on the first page, wherein the event summary information includes an indication of an earliest page on which ECG strips are presented.
 10. The method of claim 9, wherein the event summary information includes an indication of a total number of ECG strips presented in the report.
 11. The method of claim 10, further comprising monitoring summary information including an indication of a total duration of a monitoring period, which contains a number of days for which a monitoring device was prescribed to the patient, a number of dates in which monitoring occurred, a baseline date, and an end date.
 12. The method of claim 1, wherein the atrial fibrillation summary information includes total time in atrial fibrillation, number of atrial fibrillation episodes, longest atrial fibrillation, highest heart rate during atrial fibrillation, lowest heat rate during atrial fibrillation, average heart date during atrial fibrillation, highest heart rate not during atrial fibrillation, lowest heart rate not during atrial fibrillation, and average heart rate not during atrial fibrillation.
 13. The method of claim 1, further comprising presenting, on a second page, a histogram of atrial fibrillation duration, a histogram of atrial fibrillation onset, and an indication of daily atrial fibrillation burden for each of a plurality of days in the monitoring period.
 14. The method of claim 13, further comprising presenting, on the second page, total time in atrial fibrillation, number of atrial fibrillation episodes, longest atrial fibrillation, highest heart rate during atrial fibrillation, lowest heart rate during atrial fibrillation, average heart rate during atrial fibrillation, highest heart rate not during atrial fibrillation, lowest heart rate not during atrial fibrillation, and average heart ate not during atrial fibrillation.
 15. A system for filtering and indexing ECG data, the system comprising: a processor; and computer-readable memory storing instructions which, when executed by the processor, cause the processor to perform operations comprising: receiving ECG data of a patient and indications of patient-recorded symptoms from a mobile cardiac telemetry device; identifying atrial fibrillation events in the received ECG data; for each identified atrial fibrillation event, filtering the received ECG data to determine whether the identified atrial fibrillation event coincided temporally with at least one patient-recorded symptom, and labeling each such coinciding identified atrial fibrillation events as an asymptomatic AF strip and each non-coinciding identified atrial fibrillation events as an asymptomatic AF strip; generating an ECG report based on the filtered ECG data, the report comprising a sequence of a plurality of pages; presenting, on a first page in the sequence of the plurality of pages: representative arrhythmia summary information including a count of ECG strips containing each of a plurality of types of cardiac arrhythmia, and atrial fibrillation summary information including an indication of atrial fibrillation burden during the monitoring period; a count of symptomatic AF strips; and a count of asymptomatic AF strips; wherein at least one page of the plurality of pages includes an ECG strip, but the first page in the sequence does not include an ECG strip; determining a strip address by determining an earliest page of the sequence of the plurality of pages that includes an ECG strip; determining an AF summary address by determining an earliest page of the sequence of the plurality of pages that includes the atrial fibrillation summary information; and presenting, on the first page in the sequence, an address index comprising: a strip pointer comprising the strip address and, adjacent thereto, a signifier of an ECG strip; and an AF summary pointer comprising the AF summary address and, adjacent thereto, a signifier of atrial fibrillation.
 16. The system of claim 15, wherein the first page does not include a graph of ECG data.
 17. The system of claim 16, wherein the operations further comprise calculating the lower heart rate of the patient, wherein a portion of ECG data is excluded from calculation of the lowest heart rate if the portion includes a pause event.
 18. The system of claim 16, wherein the operations further comprise: receiving an artifact threshold, and calculating the highest heart rate of the patient, wherein a portion of ECG data is excluded from calculation of the highest heart rate if the portion includes an amount of artifact that exceeds the artifact threshold.
 19. The system of claim 16, wherein the representative arrhythmia summary information includes the date, time, and heart rate corresponding to: a fastest atrial fibrillation, a fastest supraventricular tachycardia, a longest pause, a slowest heart block, and a fastest ventricular tachycardia.
 20. The method of claim 19, further comprising counting of ECG strips pertaining to arrhythmia events included in the representative arrhythmia summary, wherein the representative arrhythmia summary information includes a count of ECG strips containing atrial fibrillation, a count of ECG strips containing heart block, a count of ECG strips containing pause, a count of ECG strips containing supraventricular tachycardia, and a count of ECG strips containing ventricular tachycardia. 